The availability of external fixing means fixator has opened new fields in surgery. Fixators must meet requirements for quick accurate and perfect applicability. In the case of repositioning and stable fixing of fractured small tubular bones, in particular with open fractures accompanied by injuries to bones and soft tissues, it is of utmost importance that functional ability of the body part due to lack of motion shouldn't weaken it.
In the special literature and practice J. Kearney Rogers reported in 1827 for the first time on the application of the so-called 37 bone structure". In 1853 Malgaigne was the first to use an external fixator. Berenger and Faraud were the first to use bone structure and an external fixing wooden frame. In 1894 Clayton Parkhill proposed for the first time the use of an outer fixator made of metal.
In this century, Roger Anderson applied external fixators with connecting rods assembled of pins and plaster. Generally applicable external fixators were developed by Haynes. Judet 1934, 1959) dealt with the extension of compression possibilities. Elisarev and Gudusauri (in 1972) bered through the bones with the so-called Kirschner wires, the ends of which were provided with special tensioning circular frame.
A method for external fixing of the AO-Company--Arbeitsgemein-- schaft fur Osteoxynthesefragen-- was described by Bandi in 1972, then Holz and Weller in 1975. The term "osteotaxis" is linked with Hoffmann (1959), and the method was developed by Vidal (1960, 1967) who combined the advantage of the different methods.
In World War II the apparatus of Hoffmann and Haynes was widely used. Finally Waknitz developed the so-called mini fixing means.
Presently the most widely used type are the distraction devices of Kessler, Roger Anderson, Synthes Tower and Matev. External fixing means of the Hoffmann type is also known. Recently a new type of fixator referred to as the Jaquet assembly has been proposed. In Hungary the external mini fixing means of the Hoffmann type produced by the Swiss Company Jaquet Freres are mostly used.
In course of application of the presently used widespread types of fixators for the pins, skilled work requiring high professional skills must be performed. After having fitted the bones with utmost accuracy, it is expedient to fix the ideal position in the simplest possible way. However, after reposition the injured surface must be left free to enable attention of the wound. One of the methods is the so-called cement-pin-fixation, requiring the most accurate applying of cement. For the phase of applying the cement, the proper position must be maintained. When the cement has hardened, correction becomes possible only by destroying the cement.
The external mini fixing means of Jaquet, having been developed expressly for treating the injuries of small tubular bones, can be easily manipulated by comparison of other known types of fixators. However, modelability in every direction and easy reposition requires complex equipment consisting of pliers, wrenches, guiding devices, screws, spikes, clamping means, cardan shafts, and industrial boring drills. This equipment is expensive. The fixators are made of chrome steel and generally are intended for repeated use.
Considering that a number of elements to be used in course of a surgical intervention cannot be predetermined, the whole assembly has to be at the disposal of the surgeon. Accurate adjustment of the clamping means and links requires several professional tricks. As the size of the connecting stiffening rods is given, the angles of deviations are corrected by applying a slope. The mini fixing means of the Jaquet-type has to be built-up of several components on the fixed body-part, even in the simplest cases. In case of possible change of position screwed connections have to be released and the fixing means have to be arranged in a new position.
As already mentioned, an adequate quantity of the components of the Jaquet mini-fixators has to be kept of store, as the quantity and quality of the elements to be assembled are always changing.
The patient provided with the fixator can be an out-patient, who can depart with the expensive equipment, especially if he can remove it, thus delaying the healing process. Additionally, the most expensive elements cannot be repeatedly used if they do not return to the hospital at all. Because of such permanent use, the terms of reusability of the fixators are variable. Replacement of fixators which have become lost or damaged is difficult.